Background The recent era witnessed interesting advances in the therapeutic strategies of RA with TNF-I on top of the list.
Objectives Prospectively survey factors favoring EULAR good response, DAS-28 remission, sustained response to tumor necrosis factor inhibitors (TNF-I) in biologic naïve refractory RA patients.
Methods Observational study, a follow up period of 2 years, patients randomly assigned to TNF-I (Infliximab 5mg/kg intravenous infusion, Adalimumab 40 mg subcutaneous every 2 weeks, etanercept 50 mg subcutaneous weekly). Baseline demographic features, DAS 28, functional score (health assessment questionnaire), Pain score (VAS), plain radiography, RF, ACCP-A, recorded. The primary outcome: % of patients who achieved the EULAR good response/remission [DAS-28] at 6 months, secondary measure: % of patients sustaining their initial response over 2 years.
Results Eighty RA patients 64 females,16 males, mean age of 48.4±17.9 yrs, mean disease duration 7.3±5.9 yrs,mean DAS-28 6±1, HAQ 1.25±0.35, mean ESR 51.00±25.30 mm/hr, mean CRP 35.18±31.65 mg/l, 30 patients received infliximab, 30 received adalimumab, 20 received etanercept. At 6 months 56 patients (70%) achieved EULAR good response, 51.8% achieved DAS-28 <2.6. EULAR good response/ sustained responses to TNF-I significantly correlated with a positive IgM rheumatoid factor (RF) and a higher hemoglobin concentration (Hb%) at baseline P<0.01, inversely correlated with baseline DAS-28 and radiographic erosions P<0.05 (Table 1). Achievement of EULAR good responses by 6 months and sustained response at 2 years positively correlated with the decline in RF titers during the observation period. DAS-28 remission and sustained responses negatively correlated with baseline HAQ as well as baseline DAS (r= -0.18, -0.24, -0.74, -0.85, P<0.05). Regression analysis identified higher serum Hb%, sero-positivity to RF, lower baseline HAQ, absence of erosions as significant predictors of sustained response to TNF-I (ORs=1.35, 1.35, 1.32, 1.26, P<0.05). The concomitant use of methotrexate/DMARDS was associated with favorable EULAR responses and remission at 6 months (ORs=1.13, 1.35 respectively).
Conclusions Higher baseline IgM rheumatoid factor, a higher baseline hemoglobin concentrations, a lower baseline HAQ score, lack of radiographc erosions favored an EULAR good response at 6 months and were significant predictors for a sustained response to TNF-I.
Nozaki Y, Kinoshita K, Funauchi M, Matsumura I. A response of TNFα inhibitor treatment outcome in patients with rheumatoid arthritis. OA Immunology, 2013 Apr 01; 1(1):1.
Canhão H, Rodrigues AM, Mourão AF, Martins F, Santos MJ, Canas-Silva J et al. Comparative effetiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis. Rheumatology (Oxford). 2012 Nov;51(11):2020-6.
Disclosure of Interest None declared
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